Article or Case Law Search

Article or Case Law Search

HCS/430

September 2, 2013

Article or Case Law Search

There are many cases that address the current critical regulatory issues in health care. Medicare fraud and abuse violations are only but one critical regulatory issue that is happening in America today. Medicare fraud and abuse is a major issue and it must be addressed. Many people today are lying on their applications in order to be approved for Medicare. This is hurting the people who truly need Medicare.

Nature of Medicare fraud and abuse laws

Medicare fraud and abuse is when someone will make false statements about themselves or that someone else is giving false information so the other person can get Medicare. When Medicare fraud happens it can either be a one person act or from a group of people or even an organization. Many people around commit fraud, in fact you may know someone who has already done so or may do so. “Organized crime is infiltrating the Medicare Program and masquerading as Medicare providers and suppliers” (Department of Health and Human Services, 2012).

Some forms of Medicare fraud are: When someone is billing for services but there were no supplies that were available or services, when someone has billed Medicare for appointments that weren’t made, when someone changes claim forms or makes changes to receipts in order to get higher payments.

Medicare abuse is when there is unnecessary cost in Medicare. “Abuse includes any practice that is not consistent with the goals of providing patients with services that are medically necessary, meet professionally recognized standards, and are fairly priced” (Department of Health and Human Services, 2012). Some examples of Medicare abuse is: When claims are changed with different codes, when supplies and services are overcharged, and when services were billed when it wasn’t necessary. When Medicare fraud and abuse happens it will be a criminal and civil liability.

The nature of...